ASHA MARY MANDAVA MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****22

License Status

NOT RENEWED

Business

First Name

ASHA

Middle

MARY

Last Name

MANDAVA

Suffix

Business Name

ASHA MARY MANDAVA MD

Original Issue Date

08/29/2006

Effective Date

04/24/2014

Expiration Date

07/31/2017

City

CHICAGO

State

Zip

60614

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/01/2017